Loophole means aged care resident killings 'woefully under-reported'

Elderly residents of nursing homes are dying in violent assaults carried out by fellow patients but a legislation loophole means facility operators don't have to report the abuse.

Two people die and more than 4000 assaults are reported in aged care homes every year as a result of resident-to-resident aggression, new data shows.

Aggressors in aged care facilities are more likely to be male, and younger than their victims. Credit:Jessica Shapiro

But the incidents are “woefully under-reported” because nursing home operators have discretionary powers to avoid reporting resident-on-resident aggression to the Department of Health and the police if the aggressor has dementia, the researchers said.

The vast majority of the aggressors and victims (90 per cent) had a diagnosis of dementia, according to the analysis of data from the National Coronial Information system and coroners’ files.

Senior author Professor Joseph Ibrahim, the head of the Health, Law and Ageing Research Unit within Monash University's Department of Forensic Medicine said “we don’t even understand it well enough to know what to call it”.

“There’s a spectrum of views from ‘this is murder, this is homicide’ to ‘what do you expect someone with dementia living with someone else with dementia to do?’”

Professor Joseph Ibrahim at Monash University.

Nursing home providers are required to report allegations or suspicions of abuse including unlawful sexual contact, unreasonable use of force or assault against care recipients to the Department of Health and the police within 24 hours under the Aged Care Act’s mandatory reporting framework.

But providers are not required to report suspected assaults if the alleged offender is a resident with a cognitive or mental impairment and care arrangements are put in place to manage their behaviour within 24 hours.

“This means that the most common types of resident-to-resident aggression incidents – those involving cognitively impaired residents – are never collated and publicly report on,” Professor Ibrahim said.

“So we have no way of knowing the scale and severity of the problem."

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Dr Sarah Russell, public health researcher and director of Aged Care Matters said the discretionary clause was “outrageous”.

“We need to collect this very important data” to better manage and potentially prevent aggression incidents, she said.

Minister for Aged Care Ken Wyatt said in limited circumstances approved providers are not required to report alleged or suspected assaults to the Department of Health but still must report them to the police.

But the discretionary clause allowing providers not to report some suspected assaults did not clearly distinguish between the Department of Health and the police. The Australian Law Reform Commission has also raised similar concerns about the need for clarification.

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In 2017-18 the Department of Health received 4013 notifications of assaults. Of these 3773 were required to be reported under the Act and 3226 were recorded as alleged or suspected unreasonable use of force.

Professor Ibrahim said these figures were “vanishingly small”, amounting to one or two suspected assaults per home per year across Australia’s 2700 aged care facilities.

“It doesn’t sound plausible that they could be capturing them all,” he said.

The study found 86 per cent of aggressors were male and the risk of dying from injuries inflicted by fellow residents was twice as high for men than women.

Aggressors were more likely to be younger and more recently admitted to the aged care facility.

The violent acts often occurred in communal areas in large facilities with 60 or more beds, in the afternoon or evening, and most often involved a push-and-fall type assault.

“They might say ‘you are in my chair or my house, get out’ and the other bloke is thinking the exact same thing,” Professor Ibrahim said.

“Staff are very frightened of intervening [in cases of aggression] and there are lots of occasions when staff get hurt. There’s no simple solution to it,” he said.

Roughly 40 per cent occurred in bedrooms, often when residents mistake another resident’s room for their own.

"These people with dementia are only able to communicate with simple methods," he said.

“A lot of these situations can be averted with a consistent approach, good training and skill set among staff who understand what a person with dementia needs and an environment that allows them freedom of movement."

Lead author Dr Briony Jain said without intervention an increasing number of nursing home residents will be at risk of death from aggressive acts because of Australia's growing ageing population and increasing rates of dementia.

More than half of aged care residents are diagnosed with dementia. By 2028 an estimated 589,807 Australians will have dementia. By 2058 that number will tip over one million.

CEO of Leading Age Services Australia Sean Rooney said the organisation was engaging in a consultation process with the federal government to the reporting system and believed there was scope for improving current practice.

“LASA believes that better support for providers and more research into best practice management of this issue is vital to developing effective solutions."

Mr Wyatt said the royal commission would provide an opportunity to fully understand the challenges and issues facing the aged care sector now and into the future.